青海地区慢性乙型肝炎合并结核病患者结核药所致药物性肝损伤的临床研究

Clinical Study on Drug-induced Liver Damage Caused by Tuberculosis Drugs in Patients with Chronic Hepatitis B Complicated with Tuberculosis in Qinghai

目的:探究乙型肝炎病毒感染合并结核病患者抗结核药物所致肝损伤的发病率、危险因素、治疗以及转归。方法:收集2017年7月—2020年7月青海省第四人民医院收治的乙型肝炎病毒感染合并结核病患者125例,根据病情的不同分为抗结核药物性肝损伤组和非抗结核药物性肝损伤组,分析其临床资料特征。结果:本组患者中抗结核药物性肝损伤的发病率为28%;抗结核药物性肝损伤组患者结核发生部位多于非抗结核药物性肝损伤组患者(P<0.05);抗结核药物性肝损伤组患者丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、白蛋白和凝血酶原时间活动度损害程度大于非抗结核药物性肝损伤组患者(P<0.05);肝脏硬度测定>8 kPa的患者占比抗结核药物性肝损伤组高于非抗结核药物性肝损伤组(P<0.05);乙型肝炎E抗原阳性患者的抗结核药物性肝损伤发生率高于乙型肝炎E抗原阴性患者(P<0.05)。结论:乙型肝炎病毒感染合并结核病患者中乙型肝炎E抗原阳性、肝脏硬度>8 kPa、结核多部位感染是出现抗结核药物性肝损伤的危险因素。

Objective:This study is aimed to investigate the incidence,risk factors,treatment and sequelae of anti-tuberculosis drug-induced liver injury(ATDILI)in patients with hepatitis B virus infection and tuberculosis(HBV-TB).Methods:A total of 125 patients with HBV-TB treated in the Fourth People’s Hospital of Qinghai Province from July 2017 to July 2020 were included and divided them into ATDILI group and non-antituberculosis drug-induced liver injury(NATDILI)group according to the different conditions.We will retrospectively analyze their clinical data.Results:The incidence rate of ATDILI was 28%.The site of tuberculosis in ATDILI group was more than that in NATDILI group(P<0.05).The damage degree of alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB)and prothrombin time activity(PTA)in ATDILI group was higher than that in NATDILI group(P<0.05).The proportion of patients with cirrhosis>8 kPa in ATDILI group was higher than that in NATDILI group(P<0.05).The incidence of ATDILI in hepatitis B virus E antigen(HBeAg)positive group was higher than that in HBeAg negative group(P<0.05).Conclusion:HBeAg positive,cirrhosis>8 kPa,tuberculosis multiple site infection are risk factors for ATDILI in HBV-TB patients.